By: Doug Hetherington, CEO & Program Architect at HealtH2Business

For the past fifteen years, I’ve spent my career in the healthcare industry as an insurance benefits broker. I’ve spent my fair share of time advising employers about self-funded plans and population health management. It wasn’t until about ten years ago I had a somewhat devastating realization that if my current career trajectory continued, I may never be able to retire. I wasn’t worried about myself, but what about my children and grandchildren? Who was going to pay for their healthcare? Health insurance premiums were soaring, and something had to change. I decided I would start doing everything I could to truly make an impact.

The search for a solution.

The answers did not come from my fully-insured carrier representatives, but rather subject matter experts and innovative service providers in the self-funded industry. I found the flexibility within self-funded plan architecture to be the key to creating a true cost-containment solution. With the right vendor partners, self-funded plans offer nearly endless possibilities in plan design, risk transfer and mitigation, cost savings and member engagement. I quickly learned how boxed-in I had been by the limitations of traditional plan designs, networks and antiquated processes. My optimism around the future of employer-based healthcare dramatically improved.

Taking the word to the streets.

I shared what I was learning with clients and prospects and was pleasantly surprised by their willingness to listen, learn and even execute. The idea of finally controlling employee benefit costs was motivating to many business owners and their C-suite. However, this was a comprehensive and sophisticated concept that would require all stakeholders at the table. Two key strategies for success were inviting HR representatives to participate in the discussion and exploration of what it means to be a self-funded employer. Getting the finance teams on-board to reinvest a portion of their savings back into the benefits plan in order to gain employee buy-in was essential. Basically, I did everything I had been trained not to as a benefits broker and it began to work. Employers were taking accountability across the leadership spectrum and employees were receiving better benefits for less.

Including providers in the benefits conversation.

Several years ago, I began to engage directly with providers and facilities that served my clients’ employee populations. Instead of pointing the finger and blaming them for high healthcare costs, I listened to their side of the story. I learned two very important things. First, healthcare administrators and providers are also frustrated with the way the healthcare industry is run. Their costs and prices aren’t going up as fast as deductibles and premiums, yet access, process and payment inefficiencies are becoming progressively worse. This only compounds the financial problem as a result of the fraudulent billing practices and the disparities in reimbursements between Medicare and commercial payers.

The second thing I learned from our discussions: healthcare wants to care. They want to be part of a sustainable, meaningful solution but given the current world of PPOs and networks, they are often unable to respond to local needs and provide innovative strategies to their communities. Once I had been enlightened in this it became easier to partner with my local healthcare providers because I knew we all had the same motivation – to solve a problem.

Creating a healthcare ecosystem that works for the community is essential.

I have since experienced on multiple occasions employers, providers, administrators, brokers and vendors at the table all working together for the common good of the community and their benefits. I now focus on what I call the three pillars of success: provider, employer and employee. The goal is to assure what we create is financially sustainable and meaningful for both the provider and employer. Once that is solved, we then shift our focus on creating a great experience for the employee. Can you image what you could do if the financial piece was solved and providers and employers were working together for the benefit of the employee? Can you imagine what that could do for your community?

As a benefits broker, I admit that I have sat in front of business owners and leaders and provided a complicated renewal spreadsheet with a large increase and asked them to choose the column that sucked the least. I’ll never do that again. While I have nothing but optimism and respect for health insurance and the benefits broker industry, I choose community and will continue to choose my community.

I recently spoke with Maestro Health on this very topic. Click here to download the webinar and learn more.

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